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Dear Dr. Roach: Nurse's doom and gloom spring from kernel of truth about fracture risk

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keithroach

Dr. Keith Roach

DEAR DR. ROACH: I am a 73-year-old woman. I recently fell in my house doing housework and surprisingly broke my left hip. Before the fracture I was in excellent health and extremely active. I walked daily, went to the gym and did both weight resistance and aerobic workouts. I am on no other medications other than a thyroid pill that I take daily, because my thyroid was burned out many years ago due to being overactive. I am 5 feet, 3 inches tall, weigh 115 pounds and eat healthy to maintain it. Before surgery, the surgeon's nurse told me, "You will die sooner now, probably 30% sooner because you broke your hip and you will never be the same." The doctor decided to pin it rather than give me an artificial hip because he said my bones looked well enough to hold the pins. I resumed as much physical activity as I could in a short period of time. Am I really destined to have a shortened life now and never get back to where I was?

-- S.P.

A: First off, what the nurse said may be true, on average, for a large group of people, but is NOT necessarily true for an individual. Second, what a horrible thing to say! Many patients, usually women but some men, do very well after their hip surgery. The fact that you were so active and healthy before the fall is a very good sign for your recovery and long-term prognosis, as is the fact that you have been able to recover activity quickly after the surgery. Only time will tell how much function you will recover, but it could be nearly complete.

You have at least two possible risk factors for a hip fracture. The first is that you are quite thin, with a body mass index of just 20.4, which is well below the average. This puts you at higher risk for a hip fracture, especially if you are white or Asian. The second is that you have a history of an overactive thyroid.

At your age, you should have already had an evaluation of your bone density. That number, combined with your clinical risk factors, will give an estimate of your risk for fracture. All women over 65 and postmenopausal women under 65 who have additional risk factors like yours should be screened with a dual-energy X-ray absorptiometry (DEXA) scan. Women and men at high risk for fracture should be treated with calcium and vitamin D, if necessary, and recommended medication treatment if lifestyle measures (you were already exercising well) proved inadequate at lowering your risk.

DEAR DR. ROACH: What exactly is tinnitus? What causes it? Is there a cure? Is there a treatment? What should be avoided to improve this condition?

-- M.F.

A: Tinnitus is simply the sensation of sound in or near the head when there is no external source of noise. It is usually described as a ringing or buzzing sound, and may be in one or both ears. It is extremely common (50 million people in the U.S.), and almost always goes along with hearing loss. Beyond that, the cause is not known.

Unfortunately, for most people, there is no cure for tinnitus. The goal of therapy is to lessen symptoms and to treat any associated conditions, especially anxiety, depression and sleep disturbance, all of which are common in people with severe tinnitus. I recommend the American Tinnitus Association for more advice at www.ata.org.

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